HIV, human immunodeficiency virus, is the retrovirus which causes AIDS, acquired immunodeficiency syndrome. AIDS destroys the immune system a complex set of glands, organs and tissues that help protect against and fight off diseases. HIV is bloodborne and it can only be transmitted via bodily fluids such as blood, semen and vaginal mucus. It is, therefore, sexually transmitted but can also be passed on by sharing hypodermic needles or needle stick injuries, tattoo needles, etc.

According to the World Health Organisation, regarding HIV in pregnancy:

Globally, an estimated 1.3 million women and girls living with HIV become pregnant each year. In the absence of intervention, the rate of transmission of HIV from a mother living with HIV to her child during pregnancy, labour, delivery or breastfeeding ranges from 15% to 45%. As such, identification of HIV infection should be immediately followed by an offer of linkage to lifelong treatment and care, including support to remain in care and virally suppressed and an offer of partner services.

There is a good article  in The Guardian newspaper that highlights the difference a program has made for Nigerian women with HIV during pregnancy.

Having a test meant she was able to get medication to prevent her passing the virus to her unborn baby, and her son was born HIV-free. She and her family received counselling, advice and treatment. Her husband, two other wives and another child also tested positive.

HIV in pregnancy in Ireland

Women living with HIV can give birth without passing on HIV to their baby. HIV treatment has been used safely in pregnancy for over 20 years and is key to preventing HIV from being passed on.

 

If you are thinking about or planning to have a baby, it’s a good idea to talk to your HIV doctor about how you can prepare for a healthy pregnancy.

 

In Ireland if you find out you have HIV when you are pregnant you will be referred to a HIV clinic and started on HIV treatment as soon as possible after the first trimester (first 12 weeks of pregnancy).  You will be monitored throughout your pregnancy.

 

Citation: HIV Ireland

All women except those known to be HIV positive are offered voluntary testing during pregnancy. Women can also be tested during labour using tests which can read in less than an hour. Should the result come back as positive, this will enable health care professionals to put protective measures in place to reduce the risk of the baby becoming infected.

That HIV can be passed on to the baby is not the only reason expectant mothers are advised to be HIV tested. A woman testing positive who was previously unaware of her status may need to begin anti-retroviral treatment and / or immunomodulators – drugs that alter the way in which the immune system works. She may be encouraged to review her vaccination status during pregnancy and catch up on those which would be safe for someone with a compromised immune system, that is one that is functioning below par, to receive.

It is also important that the professionals or anyone else near you during the time when you give birth are aware of your status so that any extra precautions can be taken in the event of, say, needle stick injury or loss of blood. Women who are already aware that they are HIV positive should speak to their doctors and midwife if planning to become pregnant or as early in pregnancy as possible.

March of Dimes is a charity that began in the USA in response to the Polio epidemic in the 1950s. Their fund raising and activism was key in the development of the polio vaccines that are still given today. These days, the aim of this organisation is to, “help moms have full-term pregnancies and research the problems that threaten the health of babies.”

They estimate that between one hundred and twenty thousand and one hundred and sixty thousand women in the United States have been infected with the HIV virus. Of those, approximately six to seven thousand become pregnant each year. Without adequate precautions perinatal transmission of HIV can occur.

Data collected by March of Dimes indicates that with the right medication and precautions, the risk of perinatal HIV transmission can be as low as just two per cent – a favourable comparison to the twenty five percent incidence of transmission to babies from women who receive no intervention (some of whom were undiagnosed HIV carriers).

There are many factors affecting the likelihood of passing HIV to your baby. Primary among them is the clinical state of your HIV infection also known as the viral load. This indicates just how much virus is in the blood. Of course, engaging in risky behaviour such as intravenous drug use and unprotected sex may expose you to the virus again and change the viral load. Keeping as healthy as possible and following common sense health guidelines will also help to minimise the chances of transmission.

The placenta, the sac which contains amniotic fluid and the foetus provides a barrier against HIV infection. However, drug use, urinary infections and sexually transmitted infections can compromise this barrier. Malnutrition can also have the same effect and sudden and unexpected weight loss should be reported to your physician immediately. Your care team should provide you with information on how to maintain iron, vitamin and mineral levels during your pregnancy. It may become necessary to take supplements or receive vitamin or iron injections.

Zidovudine. Also known as AZT, ZDV and Retrivir is an anti-retroviral drug prescribed to many people who are HIV positive. It may be prescribed to HIV positive pregnant women in combination with other drugs to lower the risk of perinatal transmission.
Precautions during delivery

There are also precautions to be taken during delivery. Inducing pregnancy by rupturing the placenta – amniotomy – is not advised in women who are HIV positive. Certain other procedures that may risk the baby coming into contact with its mothers bodily fluids are also to be avoided wherever possible. Caesarian section deliveries have been shown to reduce the risk of perinatal HIV transmission.

Balancing the benefits of breast feeding infants against the risk of transmitting HIV it becomes clear that the risks far exceed the benefits. A quarter of babies breast fed by mothers who are HIV positive will become infected. The risk is higher from mothers infected after birth but even when comparing women on treatment to those receiving none the rate of transmission hardly fluctuates.

Common problems that affect breast feeding mothers such as mastitis (infection that causes inflammation of the breast tissue) and thrush can greatly increase the risk of transmission of HIV to a nursing baby.

It should be noted, however, that the understanding of how the HIV retrovirus behaves in the body is becoming much better understood. Drug therapies have been developed that mean, for most otherwise healthy people who acquire this infection, it is no longer a death sentence but a chronic but manageable condition. Becoming HIV positive may not mean that this pregnancy need necessarily be the last.

Later Dating

10-17 weeks

Gynaecological Scans

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